Download PDF
Am J Perinatol 2008; 25(5): 305-309
DOI: 10.1055/s-2008-1076603
© Thieme Medical Publishers

Metabolic Assessment of the Brain Using Proton Magnetic Resonance Spectroscopy in a Growth-Restricted Human Fetus: Case Report

Humberto Azpurua1 , Arturo Alvarado2 , Finita Mayobre3 , Tamara Salom4 , Joshua A. Copel1 , Freddy Guevara-Zuloaga2
  • 1Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, New Haven, Connecticut
  • 2Facultad de Medicina Universidad Central de Venezuela, Caracas, Venezuela
  • 3Departamento de Espectroscopía y Desarrollo de Aplicaciones, Instituto de Resonancia Magnética, Caracas, Venezuela
  • 4Unidad de Terapia Cognitiva, Av Circunvalacion, Centro profesional Santa Paula Torre B, Caracas, Venezuela
Further Information

Publication History

Publication Date:
24 April 2008 (online)

    Permissions and Reprints

ABSTRACT

Proton magnetic resonance spectroscopy (MRS) is a noninvasive method to assess concentrations of different metabolites in tissues, including the brain. We evaluated a fetus with growth restriction using Doppler ultrasound and proton MRS. Doppler assessment revealed absent end diastolic flow in the umbilical artery. Diastolic flow was increased in the middle cerebral artery. Proton MRS of the fetal brain showed lactate and a low N-acetylaspartate/choline index, metabolic markers of starvation/hypoxia. Proton MRS gave us in vivo metabolic information of the brain of a fetus under starvation/hypoxic conditions. It is potentially a new tool for fetal surveillance. To our knowledge, this is the first report of cerebral lactate detection using proton MRS in a growth-restricted human fetus with no associated malformations in the English literature. Further experimental and clinical longitudinal investigations are needed to evaluate its efficacy in the clinical setting.

KEYWORDS

Fetal - brain - spectroscopy - lactate - growth - thrombophilia - pregnancy

REFERENCES

  • 1 Rantakallio P, Koiranen M, Mottonen J. Association of perinatal events, epilepsy, and central nervous system trauma with juvenile delinquency.  Arch Dis Child. 1992;  67(12) 1459-1461
    PubMedGoogle Scholar
  • 2 Stark J E, Seibert J J. Cerebral artery Doppler ultrasonography for prediction of outcome after perinatal asphyxia.  J Ultrasound Med. 1994;  13(8) 595-600
    PubMedGoogle Scholar
  • 3 Barkovich A J. MR of the normal neonatal brain: assessment of deep structures.  AJNR Am J Neuroradiol. 1998;  19(8) 1397-1403
    PubMedGoogle Scholar
  • 4 Rizzo G, Arduini D, Luciano R et al.. Prenatal cerebral Doppler ultrasonography and neonatal neurologic outcome.  J Ultrasound Med. 1989;  8(5) 237-240
    PubMedGoogle Scholar
  • 5 Wladimiroff J W, van Bel F. Fetal and neonatal cerebral blood flow.  Semin Perinatol. 1987;  11(4) 335-346
    PubMedGoogle Scholar
  • 6 Wladimiroff J W, vd Wijngaard J A, Degani S, Noordam M J, van Eyck J, Tonge H M. Cerebral and umbilical arterial blood flow velocity waveforms in normal and growth-retarded pregnancies.  Obstet Gynecol. 1987;  69(5) 705-709
    PubMedGoogle Scholar
  • 7 Montenegro N, Santos F, Tavares E et al.. Outcome of 88 pregnancies with absent or reversed end-diastolic blood flow (ARED flow) in the umbilical arteries.  Eur J Obstet Gynecol Reprod Biol. 1998;  79(1) 43-46
    CrossrefPubMedGoogle Scholar
  • 8 Liston R, Crane J, Hamilton E et al.. Fetal health surveillance in labour.  J Obstet Gynaecol Can. 2002;  24(3) 250-276 , quiz 277-280
    PubMedGoogle Scholar
  • 9 McNamara H M, Dildy III G A. Continuous intrapartum pH, pO2, pCO2, and SpO2 monitoring.  Obstet Gynecol Clin North Am. 1999;  26(4) 671-693
    CrossrefPubMedGoogle Scholar
  • 10 Lurie S, Weissman A, Blumberg G, Hagay Z. Fetal oximetry monitoring: a new wonder or another mirage?.  Obstet Gynecol Surv. 1996;  51(8) 498-502
    CrossrefPubMedGoogle Scholar
  • 11 East C E, Chan F Y, Colditz P B, Begg L M. Fetal pulse oximetry for fetal assessment in labour.  Cochrane Database Syst Rev. 2007;  (2) CD004075
    PubMedGoogle Scholar
  • 12 Posse S, Cuenod C A, Le Bihan D. Human brain: proton diffusion MR spectroscopy.  Radiology. 1993;  188(3) 719-725
    PubMedGoogle Scholar
  • 13 Kok R D, van den Berg P P, van den Bergh A J, Nijland R, Heerschap A. Maturation of the human fetal brain as observed by 1H MR spectroscopy.  Magn Reson Med. 2002;  48(4) 611-616
    CrossrefPubMedGoogle Scholar
  • 14 Kok R D, van den Berg P P, van den Bergh A J, Nijland R, Heerschap A. MR spectroscopy in the human fetus.  Radiology. 2002;  223(2) 584
    CrossrefPubMedGoogle Scholar
  • 15 Kok R D, van den Bergh A J, Heerschap A, Nijland R, van den Berg P P. Metabolic information from the human fetal brain obtained with proton magnetic resonance spectroscopy.  Am J Obstet Gynecol. 2001;  185(5) 1011-1015
    CrossrefPubMedGoogle Scholar
  • 16 Kreis R, Ernst T, Ross B D. Development of the human brain: in vivo quantification of metabolite and water content with proton magnetic resonance spectroscopy.  Magn Reson Med. 1993;  30(4) 424-437
    CrossrefPubMedGoogle Scholar
  • 17 Penrice J, Cady E B, Lorek A et al.. Proton magnetic resonance spectroscopy of the brain in normal preterm and term infants, and early changes after perinatal hypoxia-ischemia.  Pediatr Res. 1996;  40(1) 6-14
    CrossrefPubMedGoogle Scholar
  • 18 Huppi P S, Barnes P D. Magnetic resonance techniques in the evaluation of the newborn brain.  Clin Perinatol. 1997;  24(3) 693-723
    PubMedGoogle Scholar
  • 19 Maneru C, Junque C, Bargallo N et al.. (1)H-MR spectroscopy is sensitive to subtle effects of perinatal asphyxia.  Neurology. 2001;  57(6) 1115-1118
    PubMedGoogle Scholar
  • 20 Maneru C, Junque C, Botet F, Tallada M, Guardia J. Neuropsychological long-term sequelae of perinatal asphyxia.  Brain Inj. 2001;  15(12) 1029-1039
    CrossrefPubMedGoogle Scholar
  • 21 Heerschap A, Kok R D, van den Berg P P. Antenatal proton MR spectroscopy of the human brain in vivo.  Childs Nerv Syst. 2003;  19(7-8) 418-421
    CrossrefPubMedGoogle Scholar
  • 22 Zarifi M K, Astrakas L G, Poussaint T Y et al.. Prediction of adverse outcome with cerebral lactate level and apparent diffusion coefficient in infants with perinatal asphyxia.  Radiology. 2002;  225(3) 859-870
    CrossrefPubMedGoogle Scholar
  • 23 Kok R D, Steegers-Theunissen R P, Eskes T K, Heerschap A, van den Berg P P. Decreased relative brain tissue levels of inositol in fetal hydrocephalus.  Am J Obstet Gynecol. 2003;  188(4) 978-980
    CrossrefPubMedGoogle Scholar
  • 24 Tzika A A, Vigneron D B, Ball Jr W S, Dunn R S, Kirks D R. Localized proton MR spectroscopy of the brain in children.  J Magn Reson Imaging. 1993;  3(5) 719-729
    PubMedGoogle Scholar
  • 25 Heerschap A, van den Berg P P. Proton magnetic resonance spectroscopy of human fetal brain.  Am J Obstet Gynecol. 1994;  170(4) 1150-1151
    PubMedGoogle Scholar
  • 26 Heerschap A, Sommers M G, in 't Zandt H J et al.. Nuclear magnetic resonance in laboratory animals.  Methods Enzymol. 2004;  385 41-63
    PubMedGoogle Scholar
  • 27 Palacin M, Lasuncion M A, Herrera E. Lactate production and absence of gluconeogenesis from placental transferred substrates in fetuses from fed and 48-H starved rats.  Pediatr Res. 1987;  22(1) 6-10
    PubMedGoogle Scholar
  • 28 Shambaugh III G E. Ketone body metabolism in the mother and fetus.  Fed Proc. 1985;  44(7) 2347-2351
    PubMedGoogle Scholar
  • 29 Eremia S C, de Boo H A, Bloomfield F H, Oliver M H, Harding J E. Fetal and amniotic insulin-like growth factor-I supplements improve growth rate in intrauterine growth restriction fetal sheep.  Endocrinology. 2007;  148(6) 2963-2972
    CrossrefPubMedGoogle Scholar
  • 30 Toft P B. Prenatal and perinatal striatal injury: a hypothetical cause of attention-deficit-hyperactivity disorder?.  Pediatr Neurol. 1999;  21(3) 602-610
    PubMedGoogle Scholar
  • 31 Fouron J-C. Does the brain-sparing effect compensate for hypoxia?. In: Arbeille D, Maulik D, Laurini RN Fetal Hypoxia?. London; The Parthenon Publishing Group 1999: 89-98
    Google Scholar
  • 32 Bada H S, Hajjar W, Chua C, Sumner D S. Noninvasive diagnosis of neonatal asphyxia and intraventricular hemorrhage by Doppler ultrasound.  J Pediatr. 1979;  95(5 Pt 1) 775-779
    CrossrefPubMedGoogle Scholar
  • 33 Valcamonico A, Accorsi P, Battaglia S et al.. Absent or reverse end-diastolic flow in the umbilical artery: intellectual development at school age.  Eur J Obstet Gynecol Reprod Biol. 2004;  114(1) 23-28
    CrossrefPubMedGoogle Scholar
  • 34 Wienerroither H, Steiner H, Tomaselli J, Lobendanz M, Thun-Hohenstein L. Intrauterine blood flow and long-term intellectual, neurologic, and social development.  Obstet Gynecol. 2001;  97(3) 449-453
    CrossrefPubMedGoogle Scholar
  • 35 Bon C, Raudrant D, Poloce F et al.. Biochemical profile of fetal blood sampled by cordocentesis in 35 pregnancies complicated by growth retardation [in French].  Pathol Biol (Paris). 2007;  55(2) 111-120
    CrossrefPubMedGoogle Scholar
  • 36 Lin C H, Gelardi N L, Cha C J, Oh W. Cerebral metabolic response to hypoglycemia in severe intrauterine growth-retarded rat pups.  Early Hum Dev. 1998;  52(1) 1-11
    CrossrefPubMedGoogle Scholar
  • 37 Pardi G, Buscaglia M, Ferrazzi E et al.. Cord sampling for the evaluation of oxygenation and acid-base balance in growth-retarded human fetuses.  Am J Obstet Gynecol. 1987;  157(5) 1221-1228
    PubMedGoogle Scholar
  • 38 Wolfberg A J, Robinson J N, Mulkern R, Rybicki F, Du Plessis A J. Identification of fetal cerebral lactate using magnetic resonance spectroscopy.  Am J Obstet Gynecol. 2007;  196(1) e9-e11
    PubMedGoogle Scholar
  • 39 Roelants-van Rijn A M, Groenendaal F, Stoutenbeek P, van der Grond J. Lactate in the foetal brain: detection and implications.  Acta Paediatr. 2004;  93(7) 937-940
    CrossrefPubMedGoogle Scholar
  • 40 van Cappellen A M, Heerschap A, Nijhuis J G, Oeseburg B, Jongsma H W. Hypoxia, the subsequent systemic metabolic acidosis, and their relationship with cerebral metabolite concentrations: an in vivo study in fetal lambs with proton magnetic resonance spectroscopy.  Am J Obstet Gynecol. 1999;  181(6) 1537-1545
    CrossrefPubMedGoogle Scholar
  • 41 van Cappellen van Walsum A M, Heerschap A, Nijhuis J G, Oeseburg B, Jongsma H W. Proton magnetic resonance spectroscopy of fetal lamb brain during hypoxia.  Am J Obstet Gynecol. 1998;  179(3 Pt 1) 756-757
    CrossrefPubMedGoogle Scholar
  • 42 Vigneron D B, Barkovich A J, Noworolski S M et al.. Three-dimensional proton MR spectroscopic imaging of premature and term neonates.  AJNR Am J Neuroradiol. 2001;  22(7) 1424-1433
    PubMedGoogle Scholar

Humberto AzpuruaM.D. 

Yale University School of Medicine. Department of Obstetrics, Gynecology & Reproductive Sciences

333 Cedar St., PO Box 208063, New Haven, CT 06520

      >